Immuno-Histochemical Profile of Breast Cancers at the General Hospital of Douala-Cameroon

Introduction: The aim of the study was to describe the immunohistochemical aspects of breast cancers at Douala General Hospital, Cameroon. Methodology: This was a descriptive study with retrospective data collection, conducted from January 1st 2010 and December 31st 2019. It was focused on histologically proven breast cancers followed up at Douala General Hospital. Results: We collected 285 cases of breast cancer, all female, representing an annual frequency of 28.5 cases. The mean age of the patients was 48 ± 13 years. The most frequent histological form was infiltrating ductal carcinoma (83.9%), with grade II predominating (38.6%). Immunohistochemical analyses were performed on 89 patients (31.23%). The triple-negative subtype was the most common class (35.95%), followed by Luminal A (32.60);Human Epidermal Receptor 2-class and Luminal B tumors were observed at a frequency of 13.48% each. Treatment consisted mainly of surgery (78.60%) combined with chemotherapy (65.97%) and/or radiotherapy (63.16%). Hormonal treatment was used in only 10.18% of patients. Targeted therapy was exceptional (4%). Conclusion: Triple-negative phenotype is the most common. However, potentially hormone-sensitive tumors account for almost half of all patients, who are relatively young. Individualized treatments are rare. It is important to systematize these analyses for all breast cancers, with a view to appropriate management in our environment.

Evolution and Risk Factors of Maternal Mortality in Cameroon: A Case Control Study

Background: Maternal mortality is still high in sub-Saharan Africa, especially in Cameroon where more efforts to reduce maternal mortality and provide universal access to reproductive health should be made. This study aims to see the evolution of maternal mortality and identify associated risk factors in Laquintinie hospital in Cameroon. Methods: A manual review of records for 166 maternal deaths (cases) and 322 controls was undertaken using a standard audit form. The sample included pregnant women aged 16 - 46 years admitted at the maternity of Laquintinie Hospital in Douala, Cameroon from January 2017 to December 2022. Software SSPS 3 and Logistic regression analysis were used to analyze data. Results: One hundred and sixty-six (166) maternal deaths were identified during the study period for 14,114 live births, representing a maternal mortality ratio of 1176/100,000 live births. Factors significantly associated with maternal mortality included: young age (15 - 24 years) (aOR 0.11, 95% CI 0.00 - 0.76, p = 0.037), Alcohol intake (aOR 22.79, 95% CI 1.04 - 501.3, p = 0.047), Abortion or ectopic pregnancy (aOR 61.53, 95% CI 1.29 - 2927.3, p = 0.037), having no antenatal visits (aOR 388.3 95% CI 5.6 - 2675.9, p = 0.006), being admitted with hemorrhage (aOR 343.7, 95% CI 16.2 - 7276.0, p ,713.0, 95% CI 128.2 - 5,989,223.3, p CI 0.00 - 0.18, p = 0.016). Conclusion: Despite slight decrease in maternal mortality, early diagnosis of pregnancy and good Antenatal care associated with maternal health education are important factors for reducing maternal mortality. Young women were the most affected. Singles, alcoholics, women with a no or only primary education level, and referred women represented the majority of deceased cases.

Uropathogens of Urinary Tract Infection in Pregnancy and Maternal-Fetal Outcomes at the Douala Referral Hospital, Cameroon: A Case-Control Study

Background: Urinary tract infection (UTI) is common in pregnancy and accounts for a high burden of maternal and perinatal morbidity/mortality and health expenditure. The burden of this condition has been understudied in Cameroon. We aimed to determine the uropathogens of urinary tract infection in pregnancy, and the maternal-fetal outcomes of UTI at the Douala Referral Hospital. Methods: We conducted an analytic matched case-control study of 206 pregnant women with evidence of urinary tract infection (103 cases) and those without (103 controls) who underwent antenatal care and gave birth at the DRH from January 2019 to April 2019. Socio-demographic, laboratory and maternal-fetal outcome data were collected using a pre-tested structured questionnaire and analyzed with SPSS version 23. Statistical significance was set at p < 0.05. Results: Escherichia coli (51.5%), Proteus mirabilis (15.5%), Staphylococcus aureus (11.7%) and Klebsiella sp. (6.8%) were the predominant uropathogens of UTI. Maternal outcomes of UTI were puerperal pyelonephritis (AOR 3.1;95% CI: 1.11 - 3.55, p = 0.0023), preterm labor (AOR 4.4;95% CI: 1.0 - 2.7, p = 0.008) and preterm birth (AOR 4.6;95% CI 1.9 - 22.9, p = 0.05). Furthermore, low birth weight (AOR 2.1;95% CI: 0.8 - 5.6, p = 0.05), neonatal infection (AOR 13;95% CI: 0.9 - 191.6, p = 0.04) and neonatal intensive care unit admission (AOR 2.5;95% CI: 1.7 - 3.6, p = 0.003) were fetal outcomes of UTI. Conclusion: Escherichia coli was the main uropathogenic agent of UTI during pregnancy. Maternal outcomes of UTI were puerperal pyelonephritis, preterm labor and delivery while fetal outcomes include: low-birth weight, neonatal infection and neonatal intensive care admission. Prompt diagnosis of this condition is the cornerstone to avoid adverse outcomes.

Risk Factors for Breast Cancer in the City of Douala: A Case Control Study

Background: The breast cancer is an abnormal proliferation of mammary gland cells. This condition as well as other cancers is globally increasing in the world. It is the most frequent malignancy of women in the world and is a public health problem. Generally in Africa and central Africa in particular, few studies have been realized in search of risk factors of breast cancer. It’s all in this optical we began the study to determine the risk factors of this disease in the city of Douala. Patients and Methods: We conducted a case-control study, gave retrospectives collect on five years and prospectives collect on seven months. The studied population was all women aged 18 years and above with breast cancer diagnostic on histological plan for cases;and women from 18 years or more with normal physical examination and mammography. We have done our research in three reference hospitals of the city of Douala and two laboratories of pathological anatomy. The data were collected at the search files and the patients where interviewed. The parameters studied were: socio-demographic profile, clinic and Para clinic parameters, and the histological type. Results: At the end of this study, breast cancer is predominantly on young women in the city of Douala with a middle age of 44.08 ± 2.6 years. The most significant risk factors were age, age of the first birth ≥ 30 years, age of the first sexual act ≤ 18 years, low economic level, tobacco, hormonal contraceptive, parity. Conclusion: Finally, the malignancy of the breast takes a primordial place within the feminine population of Douala with many risk factors likes causes.

Etiologies of Neonatal Mortality in a Tertiary Care Hospital in a Resource-Limited Setting

Background: Neonatal mortality remains a major public health problem in low income countries. The survival within the first 28 days of life remains a challenge in such countries. Many strategies have been implemented to reduce deaths in children under five especially in sub-Saharan Africa. Laquintinie Douala Hospital benefits from some of these measures including a perinatal network and an emergency voucher. We aimed to describe the main causes of neonatal deaths at Laquintinie Douala Hospital. Methods: We carried out a cross-sectional study including files of all deceased neonates in the neonatal unit during a 24 months period from January 1st, 2017 to December 31st, 2018. Data collection included socio-demographic characteristics of the mothers and the newborns, clinical and therapeutic data and the evolution of the newborn. We used SPSS 20 software for data analysis with a p-value less than 0.05. Results: We included 270 files with an overall mortality rate of 13.1% and a sex ratio of 1.2. The main causes of death included prematurity (37.8%), neonatal infection (34.1%) and neonatal asphyxia (24.4%). The main factors associated with deaths included informal sector (OR = 5.49;95% CI 0.86 - 34.77;p = 0.07) and a primary level of education for mothers, malaria during pregnancy (OR 2.28;95% CI, 1.44 - 3.12;p = 0.0001), very preterm babies (OR 6.45;95% CI 4.68 - 8.89;p < 0.001) and resuscitation (OR 1.63; 95% CI 1.25 - 2.13;p = 0.0001). Conclusion: Neonatal mortality was lower than data in previous studies but remains high. This highlights the need for caregiver training and improvement of antenatal visits in our setting.

Pregnancies Outcome after Assisted Reproductive Technology: A Multicenter Case Control Study in a Low Income Setting Douala, Cameroon

The objective was to assess the outcome of pregnancies after assisted reproductive technology (ART). It was a case-control study carried out in four health facilities in Douala-Cameroon, over a period of five years. The cases were pregnant women who conceived through ART and the controls were those who conceived naturally. Cases and controls were matched for maternal age and parity (one case for two controls). A logistic regression analysis was used to compute Odds ratios. Statistical significance was set at 0.05. A total of 174 women who conceived through ART and 348 who conceived naturally were enrolled. Some independent factors associated with ART were: age over 45 years [aOR: 7.55; 95% CI (1.55 - 36.76);p: 0.01], twin pregnancies [aOR: 16.55; 95% CI (7.91 - 34.60);p < 0.01], Cervical cerclage [aOR: 3.04; 95% CI (1.23 - 7.50);p: 0.01], miscarriages [aOR: 11.73; 95% CI (5.07 - 27.10);p: 0.01], elective cesarean section [aOR: 4.63; 95% CI (2.27 - 9.45);p: 0.01] and low birth weight [aOR: 3.32; 95% CI (1.90 - 5.82);p < 0.01]. Women who conceived by ART were older with higher rates of multiple pregnancy and complications. We recommend transfer of a single embryo.

Adolescent Pregnancy: Epidemiological Survey in Schools and Obstetrical Outcomes in Douala (Cameroon)

Introduction: According to the World Health Organization (WHO), adolescence is the period of growth between 10 and 19 years of age. Complications from pregnancy are the second leading cause of death for adolescent girls aged 15 to 19 worldwide. Objective: In order to reduce the phenomenon of early pregnancy, we set out to determine its prevalence as well as its outcome among adolescent girls in secondary schools in the Douala 3rd district in Cameroon. Methodology: To achieve our objective, we conducted an analytical case-control study from November 08, 2018 to June 26, 2019, in ten secondary establishments in the Douala 3rd district. Included in the study were all adolescent girls, students in one of the secondary schools in the said district who agreed to participate in the study. Data analysis was done using SPSS 20.0 software. The significance threshold was set at p < 0.05. Results: A total of 445 adolescent girls were selected, including 89 cases and 356 controls. In 87.6% of the cases, the pregnancy was accidental and 58.4% used voluntary abortion. The univariate analysis of the results showed that the factor associated with the occurrence of teenage pregnancies was the age above 17 years (OR = 1.44;CI = 1.31 - 1.59) (p = 0.001). Conclusion: At the end of our study, it appeared that early pregnancies exist in Cameroonian schools with a high rate of 6.57% and an appeal to illegal abortion (62.9%).

Hematological Profile and Risk Factors of Anemia in Pregnant Women: A Cross Sectional Descriptive and Analytical Study in Douala Cameroon

During pregnancy, the hematological system undergoes numerous changes so as to meet up with the demands of the developing fetus and placenta, with major alterations in blood volume and this differs with women from different regions. The aim of this study was therefore to assess the hematological parameters and risk factors for anemia among pregnant women according to different trimesters of pregnancy in Douala, Cameroon. Methods: A cross-sectional study was conducted from February to May 2017, and all pregnant women who attended antenatal visits during our study period and who suited our inclusion criteria were recruited. The study was carried out in the antenatal care Unit of the Douala Laquintinie Hospital (DLH). A pretested questionnaire was used for the necessary data collection. Venous blood was collected from each of these women to perform a Complete Blood Count (CBC) test using an automated hematological analyzer (URIT 3010). Data were analyzed using XLSTAT 2007 and Stata version 11 software. Results: The mean age of the participants was 28 (SD = 5 years). The prevalence of anemia among pregnant women was 22% with a majority (18.4%) of these women being mildly anemic. Mean Hemoglobin values were significantly higher among women in first trimester compared to the third (12.1 ± 0.9 g/dl vs 11.8 ± 1.3 g/dl;p = 0.043). There was also a significant change in mean hematocrit (HCT) values between the first and second trimester (32.8% ± 2.5% vs 31.4% ± 2.9%, p = 0.004) and between the first and third trimester (32.8% ± 2.5% vs 30.8% ± 3.5%, p -4). RBC count value was higher in the first trimester than in the second trimester (3.7 ± 0.3 × 1012/L vs 3.5 ± 0.4 × 1012/L, p -4) and in the third trimester (3.7 ± 0.3 × 1012/L vs 3.5 ± 0.4 × 1012/L, p = 0.001). After a multivariate analysis, the following categories of women had more odds of developing anemia;women between the age range of 30 - 35 (OR = 2.81, 95%CI: 1.16 - 6.81, p = 0.023), women in the second trimester of pregnancy (OR = 2.20, 95%CI: 0.88 - 5.48, p = 0.024), women with blood group O (OR = 3.57, 95%CI: 1.41 - 16.66, p = 0.012). Conclusion: This study confirms significant variations in hematological parameters. The findings reinforce the need for supplementation and provide additional information on hematological reference values in pregnancy in Cameroon. It also helps us understand that, third trimester, age range 30 - 35, and blood group may be potential risk factors associated with anemia in pregnancy though a cohort study would be necessary to ascertain this hypothesis.

HIV+ Status and Cervical Cancer: Cytological Aspects of Cervical Smear in Cameroon Setting

Introduction: The early detection of precancerous lesions being very important for the preventive management of cervical cancer, we felt it was important to identify these lesions on potential backgrounds including HIV-positive (HIV+) women to suggest control strategies of cervical cancer in Cameroon. Objective: To determine the prevalence of precancerous lesions in women infected with the human immunodeficiency virus (HIV), to investigate the determinants of the HIV and cervical cancer association, and to make recommendations regarding cervical cancer screening in these patients of the city of Douala. Methodology: Our study was a case-control cross-sectional study from July 2017 to December 2017 (6 months) including 108 women among which 34 HIV+ matched with 74 HIV-. HIV serology was done using the complete HIV enzygnost test. Cervical smears for cytological lesions were fixed to the cyto-fixator and then stained by the Papanicolaou technique and read under an optical microscope. The cervical smear slides for viral excretion were fixed with a methanol-acetone mixture of equal volume;HPV testing was done by the indirect immune-peroxidase technique using P16 protein. The excretion of HSV type 1 & 2 was investigated by the indirect immunofluorescence technique using the Simplex Virus type 1 & 2 Rabbit anti-Herpes from DAKO (France). Results: The two groups of women were compared with the chi square test with a significance threshold of P 0.05. The average age was 40.07 with extremes of 21 and 71 years and a standard deviation of 9.99. Of the 34 HIV+ patients, 23 had an abnormal cervix compared to 36 cases of abnormal cervix among HIV- with a statistically significant difference (P = 0.006649). 12 cases of dysplasia were observed in the 34 HIV+ women and distributed as follows: 0% of mild dysplasia, 18.92% of moderate dysplasia and 13.51% of severe dysplasia. In HIV- women we detected 6 cases of dysplasia including 1.35% of mild dysplasia, 4.05% of moderate dysplasia and 2.70% of severe dysplasia. Regarding HPV infection, we observed 21 cases of HPV among 34 HIV+ women (61.76%) against 23 cases in HIV-lesions remains high in HIV+ women, hence the need to include routine screening for precancerous lesions in all HIV+ women at all ages, as well as the routine search for HPV excretion in all those with cellular dysplasia.

Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

Background: Quality control of care aims to reduce or eliminate unnecessary care and to improve the quality of those who are useful both in their indication and in their implementation. Objective: We conducted this study to assess the rate of caesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management in order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the gynaeco-obstetrics department of the Laquintinie Hospital of Douala over a period of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and who gave consent to our study as well as new-borns from these caesareans. We excluded caesarean deliveries from other health structures and referred to Laquintinie Hospital due to morbid operative follow-up. The variables collected were grouped under 3 main headings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out of a total of 967 deliveries;a caesarean section rate of 29.06% in 4 months. After data mining, 250 caesarean sections were included in the study because 31 cases of caesarean deliveries were unusable. Referred pregnancies accounted for 46.8% of the total population and the most common reason for referral was stationary labour (23% of cases). All caesareans were performed by the gynaeco-obstetricians. Women who had caesarean deliveries were informed by the operator of the surgical procedure in 28.4% of cases and 27.6% were notified of the indication for surgery. The operative kit was present in 98% of cases. The operating room was available in 93% of cases. Caesareans were performed mostly in an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in our series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative complications occurred in 3.2% of cases. Overall maternal mortality (per- and post-operative) was 0.8% (2 cases). We recorded 15 neonatal deaths out of which 8 were still births. Regarding the postoperative period, 78% of the operated patients did not have a good immediate postoperative monitoring. The post-operative protocol was not respected in 17% of cases. Postoperative complications occurred in 21.6% of patients with first cause being infections (10.8% with 5.6% being parietal suppurations). Conclusion: The frequency of Caesarean sections at Laquintinie Hospital is above the World Health Organization’s recommendations of 5% - 15%. There is a very big delay in the execution time of emergency caesareans, far above the international standards despite the quasi-availability of operating kits and the operating theatre. The state of the premises reveals a sub-workforce creating work overload and therefore a demotivation of the staff leading to insufficient communication between the operator and operated, a lack of postoperative follow-up and significant neonatal morbidity and mortality. Hence the need to initiate a staff satisfaction survey.

The Problem of Traditional African Pharmacopoeia in Obstetrics: Use of Plants for Utero-Tonic Purposes and Materno-Fetal Outcome in Douala (Cameroon)

Introduction: The use of traditional preparations for the induction or acceleration of labor remains a common practice in our country in particular and in Africa in general with sometimes derogatory outcomes for the mother and the fetus. Goal: The objective was to assess immediate maternal and neonatal outcomes in women who reported having used the traditional pharmacopoeia for utero-tonic purposes. Methodology: We conducted a multi-centric cross- sectional study with prospective data collection in the maternities of the Laquintinie Hospital, Bonassama District and Nylon Hospitals. It took place over a period of seven months, from 1st October 2016 to 31st April 2017. This included all women who reported having used the unconventional pharmacopoeia for utero-tonic purposes before or after contractions started. The student and Chi-square tests were interpreted at the statistical threshold of 5% and the 95% confidence intervals. Results: We recruited 168 cases, 68.5% of the 245 women interviewed. The mean age was 27.1 ± 0.41 years;55% of our respondents had a secondary level of education;80% of them were admitted at term and 43% were multiparous. Nulliparity predisposed to traditional pharmacopoeia use (RR = 1.55, CI = 0.79 - 3.03) but primiparity reduced this risk (RR = 0.4, CI = 0.24 - 0.926). Stimulation of labor was the first indication in 85% of women, the rectal evacuation enema was the main route used (67%). The majority of plants used were those of the families Asteraceae, Anthericaceae, and Malvaceae. In per partum, 42% had a brilliant dilatation;there was a statistically significant association between the occurrence of dynamic dystocia (CI = 0.28 - 1.54, p = 0.006) and the risk of perineal tear (RR = 3.13, CI = 1.68 - 5.85;p = 0.007). The APGAR score at 5 min of life was less than 7 in 64% of cases (p = 0.027). The caesarean section rate was 69%. Conclusion: Traditional products with uterotonic effects are frequently used and unregulated with its corollary of materno-fetal complications.

The Use of Visual Tests in the Screening Strategy of Cervical Dysplasies and Cervical Cancer at the Laquintinie Hospital Douala, Cameroon: A Cross-Sectional Study

Introduction: The prevalence of cervical cancer in Cameroon is 80.73/100,000 women, with an estimated incidence of 40/100,000 women-years. It is a real public health problem. There is no systematic and effective screening program for cervical cancer in our country, despite the advent of visual tests that are simple to use, low cost, and adapted to the modest income of our social groups. Objectives: We aimed at determining the usefulness and place of visual tests in screening for cervical dysplasia and cervical cancer for its implementation at the Laquintinie Hospital Douala, Cameroon. Methods: We conducted a prospective analytic cross-sectional study of cervical dysplasia and cervical cancer screening by visual testing at the Laquintinie Hospital Douala from December 1, 2016 to March 31, 2017. Data collection was by consecutive non-probabilistic method and consenting sexually active women older than 21 years were enrolled for study. Data analysis was with Epi InfoTM version 7. Associations were done with the Chi square, student t-test and Fischer’s exact test where appropriate. Bivariate and multivariate analysis was done and reported as odd ratios, adjusted odd ratios and 95% confidence intervals. Statistical significance was set at P 0.05. Results: We received 1590 women, of whom 1506 (94.7%) screened for dysplastic lesions and cervical cancer during the study period. The results obtained were: 1417 (94.1%) had a normal result;64 (4.2%) had a positive visual test (TV+);and 25 (1.7%) visual tests were inconclusive (TV-nC). Of the 64 women whose visual tests were positive, 15 (23.5%) were HIV+. We performed 80 colposcopies and biopsies, including 61 women with positive visual tests and 19 non-conclusive visual tests. Among women with TV+, we found 06 cancers (squamous cell carcinoma: 05, adenocarcinoma: 01) and 05 dysplasias (CIN1: 04, CIN3: 01). Histological examination in women with TV-nC revealed 02 dysplasias (CIN1: 02). Half of the women with cervical cancer were HIV+. In our series, the prevalence of cervical dysplasia and cervical cancer was respectively 05 per 1000 women and 04 per 1000 women. The early onsets of sexual intercourse and co-infection with HIV were the main factors associated. Visual tests were very sensitive (84.62%), but with a relatively low specificity (25.37%). Conclusion: Visual tests prove to be a useful tool for mass screening of precancerous and cancerous lesions of the cervix in view of its sensitivity, cost and performance.

Pregnancy Preferences in Females of Reproductive Age with Sickle Cell Disease at Laquintinie Hospital: A Cross-Sectional Analysis

Introduction: Females with sickle cell disease (SCD), despite having a delayed pubertal development, are subject to many worries relating to their abilities to conceive, their capacity to maintain a maternofetal-risk-free pregnancy till term and give birth to healthy children without sickle cell disease. Knowing that unplanned pregnancies are more likely to increase maternofetal morbidity and mortality, we sought out to explore the pregnancy preferences in female patients with sickle cell disease to promote healthy conception and childbirth in this vulnerable population. Methodology: We conducted a cross-sectional study involving female patients of child-bearing age with sickle cell disease followed at Laquintinie Hospital Douala or who were members of a local sickle cell association. Pregnancy preferences were determined using the Desire to Avoid Pregnancy (DAP) scale. Factors associated with pregnancy preferences were determined using multivariable linear regression model. Threshold for significance was set at p Results: Seventy-seven patients were included with a mean age of 24.71 ± 5.53 years. Forty patients (51.95%) had one sexual partner and thirteen women (32.5%) used contraceptive methods. Most patients (46.0%) responded “Strongly Agree” or “Agree” to the statement “it would be a good thing for me if I became pregnant in the next 3 months”. The mean DAP score was 1.63 ± 0.91 [1.28 ± 0.82 in those who had a sexual partner and 1.99 ± 0.86 in those who had no sexual partner]. Factors that were positively associated with DAP score were students (b = 0.32, 95% CI [0.21, 0.95], p = 0.003), monthly income ≥ 100,000 FCFA (b = 0.24, 95% CI [0.07, 0.81], p = 0.022), and not having a sexual partner (b = 0.26, 95% CI [0.11, 0.85], p = 0.012). Conclusion: Most female patients with SCD have a low desire to avoid pregnancy. This is especially true for patients who are not students, have a partner and have a low monthly income.